Alternatives in the treatment of abdominal rectus muscle diastasis : an evaluation

Introduction Abdominal rectus diastasis (ARD) is defined as a widening of the distance between the two rectus muscles located on either side of the Linea Alba (LA). A width of more than 3 cm is, in this thesis, considered as pathological. There are several reasons why ARD occurs, where pregnancy is one of the most common. Genetic variations in collagen composition, massive weight loss, and previous abdominal surgery are others. Patients with ARD usually perceive no pain at rest whereas discomfort, pain, corset instability and bulging of the abdominal wall are symptoms appearing during physical activity. Conclusive data regarding the most appropriate treatment of ARD are sparse, and studies with focus on abdominal wall function and quality of life after repair are lacking. Furthermore, no reliable data exist regarding evaluation of patients with ARD prior to surgery and the relevance of specific symptoms, width of ARD and abdominal wall strength. The overall aim of the present thesis was to evaluate the outcome of two surgical methods with regard to relapse of ARD; repair with a retromuscular mesh or double row self-retaining suture. Quality-of-life, pain and abdominal muscle strength were important secondary endpoints in the outcome of repair. Secondary aims were to evaluate: the effects of a dedicated training programme on symptoms and complaints from ARD; imaging and measurements of the ARD width prior to surgery; and to develop a reliable method for evaluation of abdominal wall strength. Material and methods Study I The validity and reliability of the Biodex System-4, was tested in ten healthy volunteers and ten patients with ARD ≥3 cm. The reliability of isokinetic and isometric muscle strength was assessed by test-retest with one week in between. Validity was tested by IPAQ (International Physical Activity Questionnaire) and VAS-assessment of patient-perceived muscle strength. Study II The width of ARD was evaluated clinically, with CT-scan and intra-operatively in 55 patients. Agreement between these modalities was evaluated to determine the most relevant measurement. Study III Early complications during the initial three postoperative months were monitored in 56 patients of whom 29 were randomised to repair with a retromuscular mesh and 27 to the Quill™ suture technique. All patients presented with an ARD wider than 3 cm. Study IV The same 56 patients randomised to surgery as in Study III were compared to 30 patients assigned to a training programme. Follow-up for the operated patients was at 1 year while training outcome was studied after the stated period of 3 months. Results The reliability of the Biodex System-4 was excellent as shown by ICC (Intra Class Correlation) statistics. The internal validity was excellent when compared to VAS using Spearman’s test. The external validity showed no correlation between IPAQ and isometric muscle strength using the Kendall-Tau test (Study I). Evaluation of the three methods to assess ARD showed a strong agreement (high CCC; Concordance Correlation Coefficient) between the clinical and intraoperative measurements whereas CT-scan and intraoperative measurements did not show agreement (low CCC). CT measurements underestimated the width of the ARD (Study II). Minor complications were observed three months after surgery. No significant difference between the two surgical groups in terms of early complication and perceived pain was observed. Patients in the mesh group experienced greater improvement in abdominal muscle strength (Study III). One year after surgery one recurrence was documented in the Quill group and five encapsulated seromas were distributed with no difference between the two surgical groups. Biodex System-4 showed significant improvement in all muscle strength modalities with the three methods. Quality-of-life (SF-36) domains were all significantly improved one year after surgery (p<0.001) with the exception of bodily pain (BP) in the physiotherapy group after three months of training (Study IV). Conclusions The prospective randomised trial has shown that patients with an ARD wider than 3 cm have physical symptoms and poorer quality of life than an age-matched Swedish population. Surgical intervention improves patient comfort and improves quality of life. There is no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate one year after surgery. Dedicated training strengthens abdominal muscles objectively but does not improve perceived muscle strength or pain in the abdominal wal

ARGOS - Modelling the Economic, Environmental, and Social Implications for New Zealand from Different Scenarios Relating to the Demand and Supply of Organic Products

This paper reports on some of the initial findings of the ARGOS (Agricultural Research Group on (Sustainability) programme, a 6 year quasi-experimental research project with the aim to model the economic, environmental, and social differences between organic, environmentally friendly and conventional systems of production. In the first section the paper reviews the development of organic markets, details the production costs and reports some preliminary results from ARGOS. The information is then used to develop potential future scenarios relating to the organic sector, which are assessed using the Lincoln Trade and Environment Model (LTEM), a partial equilibrium trade model that differentiates between organic and conventional production methods. This paper concentrates upon the difference between organic and conventional production, consumption and trade.sustainability, New Zealand, organic markets, ARGOS, Demand and Price Analysis, F18, Q17,

Influence of Humidity, Temperature and Radicals on the Formation and Thermal Properties of Secondary Organic Aerosol (SOA) from Ozonolysis of {\beta}-pinene

The influence of water and radicals on SOAs produced by {\beta}-pinene ozonolysis was investigated at 298 and 288 K using a laminar flow reactor. A volatility tandem differential mobility analyzer (VTDMA) was used to measure the evaporation of the SOA, enabling the parameterization of its volatility properties. The parameters extracted included the temperature at which 50% of the aerosol had evaporated (TVFR0.5) and the slope factor (SVFR). An increase in SVFR indicates a broader distribution of vapor pressures for the aerosol constituents. Reducing the reaction temperature increased SVFR and decreased TVFR0.5 under humid conditions but had less effect on TVFR0.5 under dry conditions. In general, higher water concentrations gave lower TVFR0.5 values, more negative SVFR values, and a reduction in total SOA production. The radical conditions were changed by introducing OH scavengers to generate systems with and without OH radicals and with different [HO2]/[RO2] ratios. Presence of a scavenger and lower [HO2]/[RO2] ratio reduced SOA production. Observed changes in SVFR values could be linked to the more complex chemistry that occurs in the absence of a scavenger, and indicated that additional HO2 chemistry gives products with a wider range of vapor pressures. Updates to existing ozonolysis mechanisms with routes that describe the observed responses to water and radical conditions for monoterpenes with endocyclic and exocyclic double bonds are discussed

Ett hållbart val för premiepensionen - En studie av miljö/etiskt märkta fonder i premiepensionssystemet

I uppsatsen undersöks hur 11 globala miljö och/eller etiskt märkta fonder har presterat i jämfö-relse med 17 konventionella fonder i det svenska premiepensionsutbudet genom tillämpning av utvalda finansiella prestationsmått. Detta med anledning av att miljö och/eller etiskt märkta fonder har haft en stor framväxt under det senaste decenniet och det finns därför en efterfrå-gan av att klargöra ifall en pensionssparare behöver göra avkall på den finansiella avkastningen vid val av miljö och/eller etiskt märkta fonder. En jämförelse av det statliga förvalsalternativet och 10 globala miljö och/eller etiskt märkta fonder har även gjorts för att undersöka skillnaden av att vara en aktiv respektive passiv premiepensionssparare då antalet som inte gör ett aktivt val är omkring 50 procent. Resultatet visar ingen statistisk signifikant skillnad med avseende på den riskjusterade avkastningen mellan fonder som är miljö och/eller etiskt märkta och fonder som inte tar hänsyn till dessa kriterier vilket överensstämmer med tidigare forskning. I jämfö-relsen mellan det statliga förvalsalternativet och 10 globala miljö och/eller etiskt märkta fonder har det förstnämnda presterat på en hög nivå

Analysmodellen - ett ökat förtroende för revisorn?

Revisionsbranschens förmåga att anpassa sig till stora förändringar och den snabba utvecklingen, som ägt rum i näringslivet under det senaste decenniet, har lett till en ökad fokusering på revisorers arbete. Flera stora företagsskandaler har den senaste tiden lett till ett ifrågasättande av revisionsbyråernas trovärdighet och objektivitet. Debatten har dessutom givit upphov till utredningar kring behovet av skärpta krav gällande oberoendet. För att uppfattas som oberoende måste revisorn skapa förtroende främst genom etik, moral och en hög professionalism. I Aktiebolagslagen och praxis regleras oberoendefrågor. Dessa uttrycks framför allt genom jävsregler. För att säker-ställa revisorns oberoende har det i den nya Revisorslagen tillkommit bestämmelser för hur detta ska utföras. Den 1 januari 2002 lagstiftades i Sverige om en analys-modell som bygger på att revisorn själv i alla revisionsuppdrag, med hjälp av analys-modellen, ska analysera sin opartiskhet och självständighet gentemot det reviderade bolaget. Enligt Mayer, Davis och Schoorman skapas förtroende utifrån tre hörnstenar; för-måga, välvilja samt integritet. En av revisorns uppgifter är att ge ökad trovärdighet åt årsredovisningen. Syftet är att omvärlden skall få ett ökat förtroende för årsredo-visningen när revisorn sätter sin signatur. En förutsättning för detta är att revisorn är oberoende av dem han granskar. För att säkerställa oberoendet använder sig revisions-byråer av analysmodellen för att analysera revisorns situation gentemot sina klienter. Modellen är en självgranskande modell och det är endast revisorn själv som primärt avgör hur oberoende han/hon är. Ett problem som ses med detta är om självgransk-ning är en grund att bygga förtroende på. För att branschen skall överleva, krävs att näringslivet har ett uttalat förtroende för revisorn och dennes profession. I uppsatsen frågas huruvida analysmodellen är ett hjälpmedel för revisorn vid skap-ande av ett ökat förtroende inför klienten. Syftet är att undersöka och skapa förståelse för om analysmodellen är ett hjälpmedel för att öka förtroendet för revisorer och dess arbete. De avgränsningar som görs är att endast revisorers åsikter kring förtroende, oberoende och analysmodellen beaktas. Urvalet begränsas till tre stora och tre mindre revisionsbyråer. För att samla in data används intervjuer för att få fram respondenternas åsikter och värderingar. De involverade revisionsbyråerna i undersökningen är: Lindebergs Grant Thornton, Öhrlings PricewaterhouseCoopers, Deloitte & Touch, Hurtigs Revisionsbyrå, Datarevision i Göteborg KB samt Adrian & Partners. Utifrån den empiriska undersökningen konstateras att de egenskaper som skapar förtroende för en revisor inte går i linje med den teoretiska referensramen. En själv-granskande modell kan inte ge ett trovärdigt resultat och ökar inte heller förtroendet för revisorn. Analysmodellens användande ifrågasätts, då den inte i tillräcklig utsträckning tar hänsyn till förmåga, välvilja och benägenhet samt ömsesidigt förtroende. Kritik riktas mot huruvida analysmodellen kan ses som ett hjälpmedel för ett ökat förtroende för revisorn

A universal mechanism generating clusters of differentiated loci during divergence-with-migration

Genome-wide patterns of genetic divergence reveal mechanisms of adaptation under gene flow. Empirical data show that divergence is mostly concentrated in narrow genomic regions. This pattern may arise because differentiated loci protect nearby mutations from gene flow, but recent theory suggests this mechanism is insufficient to explain the emergence of concentrated differentiation during biologically realistic timescales. Critically, earlier theory neglects an inevitable consequence of genetic drift: stochastic loss of local genomic divergence. Here we demonstrate that the rate of stochastic loss of weak local differentiation increases with recombination distance to a strongly diverged locus and, above a critical recombination distance, local loss is faster than local 'gain' of new differentiation. Under high migration and weak selection this critical recombination distance is much smaller than the total recombination distance of the genomic region under selection. Consequently, divergence between populations increases by net gain of new differentiation within the critical recombination distance, resulting in tightly-linked clusters of divergence. The mechanism responsible is the balance between stochastic loss and gain of weak local differentiation, a mechanism acting universally throughout the genome. Our results will help to explain empirical observations and lead to novel predictions regarding changes in genomic architectures during adaptive divergence. This article is protected by copyright. All rights reserved

Research rationale for the economic objective, ARGOS

The primary interest of an economist is the allocation of scarce resources to satisfy infinite“wants”, and several theories on how this can be done has been developed. The mostprominent and well known of these theories are Marxism and the neo-classical approach.The dominating theme in the post war economics has been financial growth and until the1960’s, environmental concerns were of secondary importance. From then and onwards, agrowing awareness of the social and environmental costs of financial growth has fuelled anongoing debate and contributed to approaches in economics that explicitly recognises socialand environmental aspects of the economic context.Also these “new” theories differ in the way they propose society should go about allocatingour scarce resources to different uses. However, in our opinion, they share a commonobjective, i.e. to maximize societies welfare, with welfare very broadly defined, definitelyincluding such things as clean air and nice views as well as financial aspects

Benestent II: Back to the future

It has been shown repeatedly in animal and clinical studies that heparin coating reduces thrombotic complications of several surfaces in contact with flowing blood. The demonstration that implantation of heparin-coated coronary stents is also effective in prevention of subacute thrombotic occlusion in a pig model offers the persp

Ceased grazing management changes the ecosystem services of semi-natural grasslands

Understanding how drivers of change affect ecosystem services (ES) is of great importance. Indicators of ES can be developed based on biophysical measures and be used to investigate the service flow from ecosystems to socio-ecological systems. However, the ES concept is multivariate and the use of normalized composite indicators reduces complexity and facilitates communication between science and policy. The aim of this study is to analyze how land use change affects ES and species richness and how the effects are modified by environmental factors by using composite indicators based on biophysical indicators. Using multivariate and regression analyses, we analyze the effect of grazing management abandonment in semi-natural grasslands in Norway on six ES: nutrient cycling, pollination, forage quality, aesthetics and global and regional climate regulation in addition to species richness along soil and climate gradients. Nutrient cycling, forage quality, regional climate regulation, aesthetics and species richness are larger in managed compared to abandoned grasslands. There are trade-offs among ES as different management strategies provide various ES and these trade-offs vary along environmental gradients. Management policies that aim to conserve ES need to have conservation goals that are context dependent, should recognize ES trade-offs and be adapted to local conditions

Convolutional LSTM Networks for Subcellular Localization of Proteins

Machine learning is widely used to analyze biological sequence data. Non-sequential models such as SVMs or feed-forward neural networks are often used although they have no natural way of handling sequences of varying length. Recurrent neural networks such as the long short term memory (LSTM) model on the other hand are designed to handle sequences. In this study we demonstrate that LSTM networks predict the subcellular location of proteins given only the protein sequence with high accuracy (0.902) outperforming current state of the art algorithms. We further improve the performance by introducing convolutional filters and experiment with an attention mechanism which lets the LSTM focus on specific parts of the protein. Lastly we introduce new visualizations of both the convolutional filters and the attention mechanisms and show how they can be used to extract biological relevant knowledge from the LSTM networks